Provider Demographics
NPI:1225375942
Name:ALPHA FIRST DENTAL CLINIC P.A
Entity Type:Organization
Organization Name:ALPHA FIRST DENTAL CLINIC P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OMOWUMI
Authorized Official - Middle Name:AKHUINI
Authorized Official - Last Name:IHIONKHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-242-9777
Mailing Address - Street 1:724 US HIGHWAY 259 N STE 101
Mailing Address - Street 2:
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-6042
Mailing Address - Country:US
Mailing Address - Phone:903-218-6300
Mailing Address - Fax:903-212-4210
Practice Address - Street 1:724 US HIGHWAY 259 N STE 101
Practice Address - Street 2:
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-6042
Practice Address - Country:US
Practice Address - Phone:903-218-6300
Practice Address - Fax:903-212-4210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-15
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3233496-01Medicaid